Capsule Endoscopy or Push Enteroscopy for First-Line Exploration of Obscure Gastrointestinal Bleeding?

Leusse, A de; Vahedi, Kouroche; Edery, Joël; Tiah, Djamel; Féry-Lemonnier, E.; Cellier, Christophe; Bouhnik, Yoram; Jian, Raymond

doi:10.1053/j.gastro.2006.12.002

Cited by 134 publications

(79 citation statements)

References 33 publications

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“…If sufficient numbers are enrolled, there will be a fair chance that participants with similar looking lesions are assigned to either procedure. We disagree that the morphology of most vascular lesion morphology change slowly and the reference cited by Spada et al does not support their statement (2). As we have shown in our report, there is substantial uncertainty on this very point.…”

Section: Via F Sforza 20122 Milan Italycontrasting

confidence: 86%

Capsule endoscopy in Italy: An unbalanced review of the literature

Spada¹,

Franchis²,

Pennazio³

et al. 2010

Int J Technol Assess Health Care

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We read the recently published study by Lo Scalzo et al. (4). The study is a short version of a more extensive report published on the Italian Ministry of Health Web site (1). A careful evaluation of both documents reveals several critical issues that cast doubts on the correctness of their conclusions. Usually, decisions about clinical practice should be based on levels of evidence in literature and on the strength of recommendations issued in the guidelines of international scientific societies, many of which rely on the Oxford system (Oxford Center for Evidence based Medicine) (http://cebm.jr2.ox.ac.uk/docs/level.html). As far as diagnostic tests are concerned, the Oxford system assigns the highest level of evidence to systematic reviews supported by homogeneous results. The same system assigns the second highest level of evidence to the “independent blind comparison of an appropriate spectrum of consecutive patients all of whom have undergone both the diagnostic test and the reference standard,” while the expert's opinion ranks at the lowest level. Surprisingly, the authors flatly dismissed all sequential studies that fulfill the criteria of independent blind comparison, based on the fact that they were not randomized. At the same time, they cited as source data the results of a questionnaire presented to the attendees of an Italian meeting, never published in literature, which is plainly an “expert opinion.”

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Section: Via F Sforza 20122 Milan Italycontrasting

confidence: 86%

Capsule endoscopy in Italy: An unbalanced review of the literature

Spada¹,

Franchis²,

Pennazio³

et al. 2010

Int J Technol Assess Health Care

View full text Add to dashboard Cite

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“…In this scenario, the best initial approach is probably a capsule endoscopy [28] , reserving enteroscopy (single and double-balloon) for cases in which it is necessary to apply a treatment or to obtain biopsies of lesions localized by the capsule [29,30] . This strategy significantly reduces the number of patients requiring an alternative study after an initial investigation of the small intestine.…”

Section: Iron Deficiency Anemiamentioning

confidence: 99%

A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

Bermejo

García-López²

2009

WJG

193

138

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Iron deficiency (ID), with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by enteroscopy.

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“…CE with high frame rate (PillCam Eso, Given Imaging) can be used for esophageal disorders, such as noninvasive evaluation of esophageal varices, esophagitis and Barrett's esophagus [11] . source is not identified in 3%-5% of cases despite the utilization of multiple studies [15,16] . OGIB is defined as bleeding from an unidentified source that persists and recurs after a negative endoscopy examination [16,17] .…”

Section: Indicationsmentioning

confidence: 99%

Five years’ experience with capsule endoscopy in a single center

Kav¹,

Bayraktar²

2009

WJG

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Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its efficacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bidirectional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.

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Capsule Endoscopy or Push Enteroscopy for First-Line Exploration of Obscure Gastrointestinal Bleeding?

Cited by 134 publications

References 33 publications

Capsule endoscopy in Italy: An unbalanced review of the literature

Capsule endoscopy in Italy: An unbalanced review of the literature

A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

Five years’ experience with capsule endoscopy in a single center

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